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Josephine Smit and Norman Pagett

Healthy citizens are the greatest asset any country can have.”

Winston Churchill

Faced with inevitable decline in our access to hydrocarbon resources, we read of numerous ways in which we will have to downsize, use less, work less, grow our own food, use goods and services close to home, consume only what we can manufacture within our own personal environment, or within walking distance. If we are to survive, we must ‘live local’ because the means to exist in any other context is likely to become very difficult. There is rarely, if ever, any mention of the healthcare we currently enjoy, which has given us a reasonably fit and healthy 80 year average lifespan.

There seems to be a strange expectation that we will remain as healthy as we are now, or become even healthier still through a less stressful lifestyle of bucolic bliss, tending our vegetable gardens and chicken coops, irrespective of any other problems we face. And while ‘downsizing’ – a somewhat bizarre concept in itself – might affect every other aspect of our lives, it will not apply to doctors, medical staff, hospitals and the vast power-hungry pharmaceutical factories and supply chains that give them round the clock backup. Nor does downsizing appear to apply to the other emergency services we can call on if our home is on fire or those of criminal intent wish to relieve us of what is rightfully ours. Alternative lifestylers seem to have blanked out the detail that fire engines, ambulances and police cars need fuel, and the people who man them need to get paid, fed and moved around quickly. In other words ‘we’ can reduce our imprint on the environment, as long as those who support our way of life do not. Humanity, at least our ‘western’ developed segment of it, is enjoying a phase of good health and longevity that is an anomaly in historical terms. There is a refusal to recognize that our health and wellbeing will only last as long as we have cheap hydrocarbon energy available to support it.

A year ago I asked, “How to understand health care’s inability to recognize that modern society has reached the limits to growth?”[i] Since then I’ve unsuccessfully attempted to write on the urgent and bedeviling question, “What are the nuts and bolts of organizing a “small is beautiful” health system?” Here I want to lay the ground for exploring this second question while weaving in final comments on the first question. Read the rest of this entry »

In this essay I argue that the rapid decline of Greece’s health system –and socioeconomic conditions throughout the nation- is proximately due to a fiscal/economic crisis that political and financial leaders have chosen to address by imposing draconian austerity measures upon most of the Greek people so as to: a.) protect the wealth, status and power of dominant elites, and b.) shield and resuscitate a moribund financial system. The distal cause of the deterioration of Greece’s health system, however, lies in reaching the earth’s physical limits to perpetual economic growth[i]. Therefore, attempting to restart growth –the taken-for-granted panacea- is not working and the case of Greece demonstrates that “austerity” has pernicious costs. (Stimulus is a nuanced option not developed here.)[ii] Finally, politicians, corporations and national governments are highly unlikely to recognize that the limits to growth are upon us, while local governments and grassroots citizens movements will by necessity be inclined “cyberneticly” to begin fashioning sustainable health systems (and all socioeconomic institutions) as a way surviving –even if they do not label their situation as entering a post-growth era. Read the rest of this entry »

Its central deficiency is its “priestly” style,[iii] which leads to –I believe- a Type III error: asking the wrong question[iv]. This is revealed in three passages from the lead article.[v] The first is a laudatory summary of John Holdren’s[vi] position followed by two additional passages:

Holdren highlighted the dilemma the world faces today: reliable and affordable energy is essential for meeting human needs and fueling economic growth (emphasis added), but the world’s current production, distribution, and use of energy is responsible for a series of difficult, damaging, and challenging environmental problems.

In the United States, we should encourage federal funders of research (e.g., National Institutes of Health, Centers for Disease Control and Prevention, Department of Energy, Environmental Protection Agency), industry, and foundations to fund broad-based, interdisciplinary research on the linkages among climate change, energy scarcity, ecosystem degradation, species and biodiversity losses, urban form and transportation systems, and public health.

We urge close collaboration between the Intergovernmental Panel on Climate Change and national and international energy and development institutions (e.g., Department of Energy, International Energy Agency, World Bank, International Monetary Fund).

In the social-empirical world I believe we inhabit, meeting human needs and fueling economic growth is incompatible with the thermodynamic, economic, financial (massive debt, political dominance and corruption) and environmental realities brought to the fore or worsened by peak oil. Nor do I expect corporations, politicians, and governmental and international agencies to hear the clarion call sounded by these earnest academics. These bodies have their underside agendas, as evidenced by their vain attempts to maintain the political/economic/financial status quo peak oil is upending. Bluntly, they evince little or no concern for social responsibility or the public good.[vii]

Recently I’ve received comments pointing out the futility of attempting to nudge medicine and public health onto the path of thermodynamically based sustainability. These comments were offered in good spirit, with one doctor telling me, “Mainstream health care’s going to crash. Are you sure you’re doing the right thing trying to reach them? I’ve stopped banging my head against the wall with medical leaders –they don’t give a damn and understand even less. Instead I’m building an alternative health care network.”

These comments have made me ponder the past six years in which there have been some “successes.” Yet they deservedly belong in quotation marks because my message has been largely ignored or, in some instances, absorbed into the culturally dominant paradigm of perpetual economic growth, which is breaking down, or, more directly, collapsing (not suddenly, but in increments of the reduction of social and technological complexity, mostly visited upon the economically vulnerable) for wont of cheap, low entropy energy (Gregor 2011).

Here I use Michel Foucault’s thoughts to reflect on the power/knowledge relationship as the first part of an answer to the question, “What to do about health care and public health as this collapse progresses?” In a subsequent essay I’ll rely upon Pickard (2010) to integrate Foucault’s perspective with complexity theory and ecological science. Read the rest of this entry »

Recently I spoke to a gathering of medical and public health students at Columbia University about the contribution the health sciences can make to Mayor Bloomberg’s PLANYC, a vision for a sustainable New Your City in 2030.

Although I had prepared opening remarks on how I was speaking from a paradigm premised upon the end of the physical expansion of the economy, this discussion quickly became an example of Thomas Kuhn’s incommensurability thesis. This means that proponents of competing paradigms are prone to misunderstanding and misinterpretation and, overall, “talking past” one another as they find one another’s conceptual positions and policy recommendations incomprehensible or absurd. The confusion and conflict stem from the incompatibility of the core metaphors around which the intellectual contents of paradigms are organized. In this instance it is the taken-for-granted physical growth of the economy –the core metaphor the students were operating from- versus one where economic activity is constrained by a finite planet with finite resources. Read the rest of this entry »

I’ve pondered whether to stop describing our vortex of dilemmas as a crisis of sustainability. “Sustainable growth” -and its derivative “smart growth”- has been a successful riposte to Meadows, et al’s1972 The Limits to Growth[i] that has sapped vigor and anticipation from sustainability.

Unquestionably, then, there is much to be said for jettisoning the entire notion of “sustainability.” But what can replace it? English’s massive vocabulary has no ear catching and conceptually suitable synonym. I have decided not to abandon “sustainability” for this and two additional reasons: 1) the concept is firmly planted in the nation’s collective consciousness (more on this below), and 2) it can be recaptured to synthesize the unfolding multi-dimensional (human systems and biophysical) maelstrom we are entering and help us discover ways to create a genuinely viable world. Read the rest of this entry »

In spring semester 2011 the Institute for Sustainability and Post-carbon Education at Bristol Community College in Fall River, Massachusetts will offer an online course titled, “Building Sustainable Health Systems: The Essential Role of Public Health.” The premises of this course are that 1) the structure and content of public health, medicine and nursing will be deeply transformed as society reaches the limits to growth and 2) public health is critical to all socioeconomic localization and community building. The course is designed to allow public health professionals and members of the community to work synergistically and strategically as ecologically mandated social change emerges. Read the rest of this entry »

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